Hip replacement and knee replacement are commonly performed surgical procedures, with more than 800,000 hip operations carried out worldwide each year (Knutsson 1999). The main indication for total hip or total knee replacement is intractable pain that cannot be controlled by conservative treatment alone (Brady 2000). Leading causes of such pain include arthritis, trauma, congenital abnormalities, dysplasia and osteochondritic disease (Brady 2000). However, the main clinical reason for this type of surgery is osteoarthritis (Gammon 1996).

Osteoarthritis is a disabling disease that involves degradation and destruction of the hyaline cartilage in synovial joints. The most powerful risk factor for osteoarthritis is age, with 68 per cent of individuals over the age of 55 exhibiting radiographic evidence of osteoarthritis (Elders 2000). In steadily ageing populations the prevalence of osteoarthritis is increasing, and consequently the impact on chronic disability and costs is rising (Elders 2000). In the absence of a curative treatment, management of osteoarthritis is directed primarily towards relief of pain and functional limitation. Surgery is a treatment option for patients in whom medical treatment has failed to provide adequate symptom relief (Creamer 1998).

Total hip or total knee replacement is a major surgical procedure, followed by a period of hospitalisation incorporating in‐patient physiotherapy and usually further out‐patient rehabilitation (Palmer 1999). These events can be stressful, compromising the patient both physically and psychologically (Gammon 1996). If a patient is unduly anxious, recovery may be affected, prolonging length of hospital stay and hence cost of care and patient well‐being. It is hypothesised that patient education prior to undergoing total joint replacement will reduce stress and enhance the outcome immediately following surgery.

Average length of stay for hip replacement surgery varies from 5 to 39 days (Wang 1997). For knee replacement surgery, length of stay ranges from 7.3 ± 2.6 days to 11.8 days (Lingard 2000; Weingarten 1995). Length of stay in hospital depends on the physical recovery of the patient, which relates to post‐surgical complications, pain, coping ability, compliance, and mobility and independence levels. Of particular importance in determining length of stay is the occurrence of post‐operative complications, the most serious of which is the presence of a pulmonary embolus resulting from deep vein thrombosis (Brady 2000). This occurs in 50‐70 per cent of all unprotected (i.e. non anti‐coagulated) patients, and is a leading cause of post‐surgical morbidity and mortality (Morris 1998). Prevention of deep vein thrombosis can potentially be aided by pre‐operative assessment to identify risk factors and post‐operative exercise (Morris 1995).

A second cause of early stage morbidity for hip joint replacements concerns dislocation, which may result when post‐surgical contraindications and protocols are not followed. It is essential that patients undergoing total hip joint replacements understand positions to avoid. This understanding is potentially enhanced by pre‐operative education.

It is generally agreed that perception of pain and anxiety is heightened when patients feel a lack of control over their situation. By ensuring full understanding of surgery and post‐operative routine and promoting physical recovery and psychological well‐being through preparatory informative sessions, it is hypothesised patients will be less anxious, have a shortened length of stay, suffer fewer post‐operative complications and be better able to cope with post‐operative pain.